Bupropion/naltrexone, sold under the brand name Contrave, is a prescription weight loss medication approved for adults who are overweight or obese. It’s not a GLP-1 drug (like Wegovy or Saxenda) — instead, it works on the brain to help reduce appetite and control cravings.
⚙️ What Is Contrave?
| Medication | Contrave (bupropion + naltrexone) |
|---|---|
| Drug Class | Atypical antidepressant + opioid antagonist combination |
| Form | Oral tablet (taken by mouth) |
| Dosing | Typically 2 tablets in the morning and 2 in the evening |
| FDA Approved | 2014 |
| For Whom? | Adults with: |
| – BMI ≥30 (obese) | |
| – BMI ≥27 + weight-related condition (e.g., diabetes, high blood pressure) |
🧠 How It Works
Contrave targets areas of the central nervous system involved in:
- Appetite regulation
- Reward and cravings
- Impulse control
Specifically:
- Bupropion (also used in Wellbutrin): Boosts dopamine and norepinephrine, reducing appetite and improving mood.
- Naltrexone (used to treat alcohol/opioid dependence): Blocks opioid receptors, dampening cravings and reducing food-related reward.
➡️ Together, they reduce hunger and control food cravings, particularly for highly palatable foods.
📉 How Effective Is It?
| Result | Details |
|---|---|
| Average Weight Loss | ~5–9% of body weight over 1 year |
| More Effective With Lifestyle Change | Up to ~10% when combined with diet & exercise |
| % of Users Losing ≥5% | ~48% (vs. 16% with placebo) in clinical trials |
It’s less effective than newer drugs like semaglutide (Wegovy), but may still be useful for the right person.
⚠️ Common Side Effects
| Side Effect | Approximate Frequency |
|---|---|
| Nausea | ~30% |
| Constipation | ~19% |
| Headache | ~18% |
| Insomnia | ~14% |
| Dry mouth | ~13% |
| Dizziness | ~10% |
| Anxiety | ~10% |
Note: These are most likely during the initial weeks, especially as the dose increases.
❗ Serious Risks (Rare but Important)
- Increased blood pressure & heart rate – must monitor in people with hypertension.
- Seizure risk – especially in those with a history of seizures or eating disorders.
- Suicidal thoughts/behavior – due to the bupropion component (black box warning).
- Liver toxicity – mostly related to the naltrexone component.
⚠️ Contraindicated in:
- People with uncontrolled high blood pressure
- History of seizures
- History of anorexia or bulimia
- Use of opioids (naltrexone blocks opioid receptors)
- Taking other forms of bupropion (like for depression or smoking)
💊 Dosing Schedule
Contrave uses a gradual dose escalation:
| Week | Dose |
|---|---|
| Week 1 | 1 tablet in AM |
| Week 2 | 1 tablet AM, 1 tablet PM |
| Week 3 | 2 tablets AM, 1 tablet PM |
| Week 4+ | 2 tablets AM, 2 tablets PM |
Taken twice daily with food (morning and evening).
💰 Cost & Insurance
- Brand name only — no generic as of now
- Can cost $99–$1300/month, depending on insurance and pharmacy
- Savings cards from the manufacturer may reduce cost for eligible patients
🧭 Summary
| Pros | Cons |
|---|---|
| Oral pill — no injection needed | Lower weight loss than GLP-1 drugs |
| Reduces appetite + cravings | Risk of nausea, insomnia, anxiety |
| May be good for emotional eaters | Not safe for people with seizures, high BP, or on opioids |
| Also improves mood in some cases | Black box warning for suicidal thoughts |
Should You Consider Contrave?
Contrave can be a good option if:
- You prefer oral meds over injections
- You struggle with emotional or binge eating
- You can’t use GLP-1 drugs for medical or insurance reasons
But it’s not ideal if you:
- Have seizure risk
- Use opioids
- Have uncontrolled blood pressure
Would you like help comparing Contrave to a GLP-1 like Wegovy or Saxenda?
